EVAR found superior to open AAA repair for long-term survival in Medicare patients: Another nail in open surgery’s coffin?

In a recent article, Jackson et al1 reported the findings from a comparison of long-term survival after open repair (OR) versus endovascular repair (EVAR) of intact AAA among Medicare beneficiaries. It was a retrospective analysis of patients aged 65 or older in the Medicare Standard Analytic File who had repair of non-ruptured AAA from 2003 to 2007. The investigators concluded that, when compared with EVAR, OR was associated with a higher risk of all-cause mortality and aneurysm-related mortality.

The study comprised 4,529 patients in total, 703 having OR and 3,826 EVAR. Mean and median follow-up times were 2.6 and 2.5 years, respectively. The primary endpoint was all-cause mortality. Secondary outcomes were also analyzed: AAA-related mortality, hospital length of stay, 1-year readmissions, redo repair, incisional hernia repair, and lower extremity amputation. Cause of death was determined from the National Death Index. The investigators reported that an unadjusted analysis showed that in OR versus EVAR, both all-cause mortality and aneurysm-specific mortality were higher for surgical treatment. After adjusting for emergency admission, age, calendar year, sex, race, and comorbidities, there was a higher risk of both all-cause mortality and AAA-related mortality after OR versus EVAR and this difference was statistically significant.

The adjusted hospital length of stay was, on average, 6.5 days longer after OR (mean, 10.4 days), compared with EVAR (mean, 3.6 days). The incidence of incisional hernia repair was higher after OR, whereas the 1-year readmission rate, repeat AAA repair, and lower extremity amputation were not significantly different.



  1. Jackson RS, Chang DC, Freischlag JA. Comparison of long-term survival after open vs endovascular repair of intact abdominal aortic aneurysm among Medicare beneficiaries. JAMA. 2012;307(15):1621-1628.

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